Common Name:



|Property Name: |      |

|Street Address: |Street #: |      | |      |Apartment #: |      | |      | |

| | |(Low) | |(High) | |(Low) | |(High) | |

|Prefix: |      |Street Name: |      |Suffix: |      |Type: |      |

|County(s): |      |Zip Code: |      |

|Municipality(s): |      |Block(s): |      |

|Local Place Name(s): |      |Lot(s): |      |

|Ownership:: |      |USGS Quad(s) |      |

| |

|Description:       |

|Registration and Status |National Historic |      |SHPO Opinion: |      |

|Dates: |Landmark: | | | |

| |National Register: |      |Local Designation: |      |

| |New Jersey Register: |      |Other Designation: |      |

|Determination of Eligibility: |      |Other Designation Date: |      |

| |

|Photograph: |

|5” x 3.5” – Please mount photos as indicated. |

|For portrait oriented photos, mount with the top to the left |

|Survey Name: |UNPROTECT DOCUMENT (tools>unprotect); ENTER APPROPRIATE INFO HERE; |Date: |January 25, 2001 |

|Surveyor: |CUT AND PASTE THIS TABLE AND ASSOCIATED HORIZ. LINE ABOVE INTO | |

|Organization: |DOCUMENT FOOTER; Re PROTECT DOCUMENT (tool>protect document, as form) | |

|Location Map: |Site Map: |

| | | |

| |

|Bibliography/Sources:       |

|Additional Information:       |

|More Research Needed? | Yes | No |

| |

|INTENSIVE LEVEL USE ONLY | | |

|Attachments Included: | Building | Structure | Object | Bridge |

| | Landscape | Industry | |

|Within Historic District? | Yes | No | |

| |Status: | Key-Contributing | Contributing | Non-Contributing |

|Associated Archaeological Site/Deposit? | Yes | | | |

|(Known or potential Sites – if yes, please describe briefly) |

|      |

THIS PAGE TO BE COMPLETED ONLY AT INTENSIVE LEVEL

AND

ONLY IF PROPERTY IS A FARM COMPLEX

|Historic Farm Name: |      |

|Period of |      |To |      |Source |      |

|Agricultural Use: | | | | | |

|Agriculture Type: |      | |

|Remaining Historic Fabric |      | |

|Acreage: |      | |

| |

|Farm Description: |

|      |

|History:       |

| |

|Significance:       |

|Eligibility for New Jersey and National | Yes | No |National | A | B | C | D |

|Registers: | | |Register Criteria: | | | | |

|Level of Significance | Local | State | National | |

| |

|Justification of Eligibility/Ineligibility:       |

|For Historic Districts Only: |

|Property Count: |Key Contributing: |      |Contributing: |      |Non Contributing: |      | |

| |

|For Individual Properties Only: |

| List the completed attachments related to the property’s significance: |

| |      | |

| | | |

| | | |

| | | |

|Narrative Boundary Description:       |

New Jersey Historic Preservation Office

Survey Form Instructions

Introduction

The HPO survey forms are designed to collect and organize the information needed to assess the eligibility of historic properties for listing in the New Jersey and National Registers of Historic Places. None of the forms are as detailed as a National Register of Historic Places nomination. Each type of survey form has a set of instructions for its completion, organized according to its data fields. There are different forms available for documenting New Jersey's districts and properties. The system of forms consists of a Base Form, Attachments, the Historic District Overlay, and an Eligibility Worksheet. Attachments prompt the surveyor to provide information tailored to the evaluation of particular elements that make up a property. These forms also make the recorded information easily accessible and enable the user to group resources into subtypes thereby allowing the development of specific contexts for future evaluation. See Section 1.6 of the Architectural Survey Guidelines for additional information and examples of form usage. The following list provides a brief description of each form and how it should be used.

Base Form:

This form is used in all surveys to record basic background and geographical data for all types of properties. For reconnaissance-level surveys, this form is the only form used. For intensive-level surveys, this form is the first step in documenting the property. See notes below regarding surveying farm complexes.

Historic District Overlay:

This form is used only at the intensive level to record basic background and descriptive information about the historic district. It documents the district as a whole. Properties within the historic district are represented by Base Forms and Attachments, as appropriate.

Attachments:

Attachments are used only at the intensive level to record specific information about specific elements that make up a property. Attachments will always refer to the property recorded onthe Base Form. A property may have a variety of elements that relate to its significance, therefore, any number of Attachments may be completed for a particular property.

For planning surveys: Attachments will be completed for properties that were recommended for further research in the reconnaissance-level report, or for properties that would be considered key-contributing properties in historic districts.

For regulatory surveys: Attachments will be completed for properties that are over fifty years of age and are subject to impacts of an undertaking.

Building, Structure & Object Attachments: These attachments are used only at the intensive level to document the buildings, structures or objects that make up a property. These attachments should always be used in conjunction with a Base Form, and other Attachments as appropriate [n.b. These were formerly combined as the Building/Element Attachment.]

Bridge Attachment: This attachment is used only at the intensive level to document bridges and culverts. This attachment should always be used in conjunction with a Base Form, and other Attachments as appropriate.

Landscape Attachment: This attachment is used only at the intensive level to document designed landscapes (versus cultural or traditional landscapes). Designed landscapes may be an element of a larger property (a kitchen garden on an estate), or may be the "major element" of the property (a large urban park), in which case the form serves to document the landscape as a whole. Additional elements within the landscape (bridges, buildings, etc.) should be documented on their own Attachments. (Cultural or traditional landscapes should be recorded using the Historic District Overlay.)

Farm Attachment: This attachment has been deleted from the survey form system. It was included in the printed Guidelines, but the information requested is now located on the Base Form, as a third page, to be completed only at the intensive level and only when the property in question is a farm complex. (See Base Form instructions below).

Industrial Building Attachment: This attachment is used only at the intensive-level to document industrial buildings. Each significant industrial building of the property should be documented on an Industry Attachment. Additional elements within the industrial complex (non-industrial buildings, bridges, structures, etc.) and should be documented on their own Attachments. This Attachment should always be used in conjunction with a Base Form, and other Attachments as appropriate. [n.b. formerly titled Industry Attachment]

Eligibility Worksheet:

This form should be used only at the intensive level to assess eligibility for historic districts or individual properties.

For planning surveys: The Worksheet will be completed for historic districts as recorded on the Historic District Overlay, and individual properties that were recommended for further research in the reconnaissance level report.

For regulatory surveys: The Worksheet will be completed for individual properties that are over fifty years of age and are subject to impacts of an undertaking, or historic districts as recorded on the Historic District Overlay.

Continuation Sheet:

This form should be used at the reconnaissance or intensive level to attach additional text, photographs or other illustrations to continue or amplify any survey form or attachment.

Base Form Instructions

General Instructions:

This form should be used to record basic background and geographical data for surveys. For reconnaissance-level survey, this form is the only one used to document a property. For intensive-level survey, this form is the first step in documenting the property, and Attachments should be competed for specific elements (i.e. buildings, bridges, landscapes). Any and all questions about completing the forms should be directed to the HPO. There are some fields for which data lists are provided. In such cases, please choose the most appropriate word from the supplied list. For information that is not known, write "unknown" in the appropriate blank. For fields which are not applicable to the property in question, write "N/A" in the appropriate blank. Continuation sheets may be used for additional text, photographs, and other graphics.

Field Instructions:

|Historic Sites # |This field is for HPO use only. This number is an alphanumeric code used to uniquely identify all surveyed |

| |properties. This number will be assigned by the HPO once the form is received. For intensive-level surveys, this |

| |number will be the same for all attachments. |

| | |

|Surveyor Information |At the bottom of all pages, note the name of the survey, and include the name(s) of the person(s) completing the |

| |form. If two or more people were involved in the research and writing, include all names. Include the name(s) of the |

| |surveyor, preparer and sponsor, if different. Also include the date on which the form was completed. |

| | |

|Property Name |Give the common or most descriptive name of the property. |

| | |

|Street Address |Please provide the legal address of the property being surveyed. In the near future, addresses will be used to locate|

| |surveyed properties in the HPO's GIS system, and these fields are designed to ensure consistency in specifying this |

| |information. Whenever possible, use the official name of the roadway, rather than its numeric designation (e.g., use |

| |the name "Main" rather than "Route 36"). For example, an address such as: "501 East State Street" would be recorded |

| |as: LowNumber = 501, Prefix = E, Name = State, and Type = ST. |

| |Low Number: Provide the street number of the property. If there is a single number for this property, place it in |

| |this field. If there is a range of numbers for the property (e.g., 69-73), place the lowest number in this field, and|

| |the highest number in the High Number field. This field is restricted to numeric entries. |

| |High Number: If there is a range of numbers for the property (e.g., 69-73), place the highest number in this field. |

| |This field is restricted to numeric entries. |

| |Low Apartment: If applicable, provide the apartment number of the property. If there is a single number or letter |

| |indicating an apartment or unit place it in this field ("1" or "A" or "1A" are all valid entries). If there is a |

| |range of apartment or unit numbers or letters (e.g., 1 through 4 or A through D), place the lowest number or letter |

| |in this field, and the highest number or letter in the HighApartment field. |

| |High Apartment: If there is a range of apartment or unit numbers or letters (e.g., 1 through 4 or A through D), place|

| |the highest number or letter in this field. |

| |Prefix: This is a restricted data field. If applicable, indicate the prefix associated with the roadway name: N, S, |

| |E, W, NW, NE, SW, SE. |

| |Name: Provide the full name of the roadway without any prefixes, suffixes, or type designations. For example, enter |

| |"Main" in this field. Do NOT enter "S Main St" in this field. The "S" is a prefix and should be entered in the |

| |prefix field. The "St." is a type and should be entered in the TYPE field. For federal, state or county highways, |

| |that do not have official names, please use the following conventions: |

| | For federal highways, write out the name as follows: US Hwy 95 |

| |For state highways, write out the name as follows: State Hwy 18 |

| |For county highways, write out the name as follows: County Hwy 351 |

| |Suffix: This is a restricted data field. If applicable, indicate the suffix associated with the roadway name: N, S, |

| |E, W, NW, NE, SW, SE, EXT. |

| |Type: This is a restricted data field. From the list provided, indicate the type of roadway: |

| |Avenue |AVE |Ramp |RAM |

| |Boulevard |BLVD |Road |RD |

| |Circle |CIR |Route |RTE |

| |Court |CT |Street |ST |

| |Drive |DR |Terrace |TER |

| |Freeway |FWY |Thoroughfare |THFR |

| |Lane |LN |Turnpike |TPKE |

| |Parkway |PKWY |Way |WAY |

| |Place |PL | | |

| | |

| |In a few cases, addresses may be entirely absent. For these unusual cases, please indicate the nearest intersection |

| |of two streets. Fill out the following fields for each of the intersecting streets: |

| | |

| |For the first intersecting street: |

| |Prefix1: Defined as above. |

| |Name1: Defined as above. |

| |Suffix1: Defined as above. |

| |Type1: Defined as above. |

| | |

| |For the second intersecting street: |

| |Prefix2: Defined as above. |

| |Name2: Defined as above. |

| |Suffix2: Defined as above. |

| |Type2: Defined as above. |

| | |

|County and |These are restricted data fields. Give the full name of the county and incorporated municipality in which the |

|Municipality: |property is located. If located in multiple municipalities (or counties), list all those that apply. The allowable |

| |data can be found in the New Jersey Local Place Names list available from the HPO |

| | |

|Zip Code: |Give the postal zip code for the area in which the property is located. |

| | |

|Local Place Name: |When applicable, give the local place name in which the property is located (i.e. Ocean Grove which is in Neptune |

| |Township). A list of local place names is available from the HPO. |

|Block: |Municipal tax identification number, available from the local tax maps or tax assessor's office. List all that apply |

| | |

|Lot |Municipal tax identification number, available from the local tax maps or tax assessor's office. List all that apply |

| | |

|Ownership |This is a restricted data field. Indicate whether the property is owned by a Public, Private, or Non-profit entity. |

| | |

|USGS Quad |This is a restricted data field. From the following list, note the full name(s) of the United States Geological |

| |Survey (USGS) quad on which the property appears. List all that apply. |

| | |

| |Adelphia |Frankford |Perth Amboy |

| |Allentown |Franklin |Philadelphia |

| |Alloway |Freehold |Pine Island |

| |Arthur Kill |Frenchtown |Pitman East |

| |Asbury Park |Gladstone |Pitman West |

| |Atlantic City |Green Bank |Pittstown |

| |Atsion |Greenwood Lake |Plainfield |

| |Avalon |Hackensack |Pleasantville |

| |Bangor |Hackettstown |Point Pleasant |

| |Barnegat Light |Hamburg |Pompton Plains |

| |Beach Haven |Hammonton |Port Elizabeth |

| |Belvidere |Heislerville |Port Jervis South |

| |Ben Davis Point |High Bridge |Port Norris |

| |Bernardsville |Hightstown |Portland |

| |Beverly |Hopewell |Princeton |

| |Blairstown |Indian Mills |Ramsey |

| |Bloomsbury |Jamesburg |Raritan |

| |Bombay Hook |Jenkins |Riegelsville |

| |Boonton |Jersey City |Rio Grande |

| |Bound Brook |Keswick Grove |Rocky Hill |

| |Branchville |Keyport |Roosevelt |

| |Bridgeport |Lake Messkenozha |Roselle |

| |Bridgeton( NJ) |Lakehurst |Runnemeade |

| |Brigantine Inlet |Lakewood |Salem |

| |Bristol |Lambertville |Sandy Hook |

| |Brookville |Long Beach |Sea Isle City |

| |Browns Mills |Long Branch |Seaside Park |

| |Buena |Lumberville |Shiloh |

| |Bushkill |Marcus Hook |Ship Bottom |

| |Caldwell |Marlboro |Sloatsburg |

| |Califon |Marmora |South Amboy |

| |Camden |Mays Landing |Stanhope |

| |Canton |Medford Lakes |Stockton |

| |Cape Henlopen |Mendham |Stone Harbor |

| |Cape May |Milford |Stroudsburg |

| |Cassville |Millville |Taylors Bridge |

| |Cedarville |Monmouth Junction |The Narrows |

| |Central Park |Moorestown |Toms River |

| |Chatham |Morristown |Tranquility |

| |Chatsworth |Mt. Holly |Trenton East |

| |Chester |New Brunswick |Trenton West |

| |Clementon |New Egypt |Tuckahoe |

| |Columbus |New Gretna |Tuckerton |

| |Coney Island |Newfield |Unionville |

| |Culvers Gap |Newfoundland |Wanaque |

| |Delaware City |Newton East |Washington |

| |Dividing Creek |Newton West |Wawayanda |

| |Dorothy |Newtownville |Weehawken |

| |Dover |Nyack |West Creek |

| |Easton |Ocean City |Whiting |

| |Egg Harbor City |Oceanville |Wildwood |

| |Elizabeth |Orange |Williamstown |

| |Elmer |Oswego Lake |Wilmington South |

| |Farmingdale |Park Ridge |Woodbine |

| |Five Points |Paterson |Woodbury |

| |Flatbrookville |Pemberton |Woodmansie |

| |Flemington |Pennington |Woodstown |

| |Forked River |Penns Grove |Yonkers |

| |Fortescue | | |

|Description |This section should be used to give the reader a clear mental image of the nature and type of property being |

| |surveyed. It should note the basic form and style of the property as well as any character-defining features. |

| |References to materials, construction, and compositional techniques should be used whenever possible. This narrative |

| |should also elaborate upon significant exterior materials and designs, and discuss major alterations and their dates.|

| |On-site inspection and/or comparison with other properties may lead to theories on construction, styles, dates, |

| |alterations, etc. If, in the course of a reconnaissance-level survey, a potential historic district is observed, |

| |include that information in the description (i.e., "surrounding commercial downtown area has historic district |

| |potential"). |

| | |

|Registration and |Provide dates for when all or part of the property was listed on the New Jersey or National Registers of Historic |

|Status Dates |Places. Also indicate Yes or No if all or part of the property is a National Historic Landmark (NHL). Provide dates if|

| |the property has a Determination of Eligibility (DOE) from the Keeper of the National Register, a SHPO Opinion, or if |

| |the property has been designated historic through a formal local process. Under "Other", note the date of when all or |

| |part of the property was recognized in another way (i.e. listed as historic in a county-wide survey, municipal master |

| |plan, etc.) Dates should be entered in a completely numerical format (i.e.: 04/14/82 not April 14, 1982). |

| | |

|Photograph |A 35mm 35" x 5" black-and-white or color photograph that gives the most informative view of the property should be |

| |attached directly to the form. Generally, with a free-standing resource, a front and side view filling 75% of the |

| |print is recommended. The image can be either portrait or landscape orientation in the photograph; however, the |

| |photograph must be mounted as indicated on the form (attach portrait oriented photographs with the top to the left). |

| |Additional photographs may be mounted to continuation sheets. |

| | |

|Location Map |Include a 2" x 3" map which shows the location of the property being surveyed. The map should be a digital ortho-photo|

| |quarter quad, available from NJDEP map scales or a variety of world wide web sites. USGS topographic maps are |

| |acceptable and municipal maps are also acceptable, provided they show enough context to identify the location on other|

| |map sources. Include a north arrow and bar scale. |

| | |

|Site Map |This map should be included for intensive-level surveys only. This map is necessary when there is more than one |

| |element per property, and should be used to show the relationship of the elements to each other (i.e. a house with |

| |significant outbuildings as recorded on the Base Form, and Building/Element Attachments. The map should be a municipal|

| |tax map or digital ortho-photo quarter quad. Include a north arrow and bar scale. |

| | |

|Bibliography/ |Include citations of research sources consulted regarding the property. |

|Sources | |

| | |

|Additional Information |Provide any additional information relevant to the property. |

| | |

|For Reconnaissance-Level Survey Only |

|More Research Needed |Indicate Yes or No to note whether this property warrants further research at the intensive level based on the initial|

| |survey findings. |

| | |

|For Intensive-Level Survey Only |

| | |

|Attachments Included |Indicate the number of additional forms attached to this Base Form |

| | |

|Historic Districts |Indicate Yes or No to note whether this property is included within the boundaries of an existing or potential |

| |historic district. |

| |Name: Indicate the name of the existing or potential historic district that encompasses this property. |

| |Key Contributing/Contributing/Non Contributing: Indicate how this property relates to the existing or potential |

| |historic district by checking one of these categories. |

| | |

|Associated Archaeological |Indicate if there are any known prehistoric or historic archaeological sites or deposits associated with the property.|

|Site/Deposits |If any are known or there is the potential for an associated site or deposit, please describe. |

| | |

|Farm Complexes |Please note that these data-fields consider the farm as a whole, and should refer to the entire historic property as |

| |described above on the Base Form. Additional attachments should be included for other significant elements (farmhouse,|

| |barns, outbuildings, etc.) that make up the property. |

| |Historic Farm Name: The historic name could be the earliest known name, the name of the original owner, the name of |

| |the most significant occupant, or the complex's most significant use. If several historic names are known, use the one|

| |most closely associated with the most salient aspects of its history. |

| |Period of Agricultural Use and Source: If known, please give the period of time for which the complex has been used |

| |for agricultural purposes. Source of information (i.e. personal interview with owner or local historian) must be |

| |cited. |

| |Agriculture Type: This is a restricted data field. Using the following list, indicate what type of agricultural |

| |complex is being surveyed. If the complex embodies more than one type, choose the most predominant and include the |

| |others in the description. The list of allowable data is adapted from the 1997 North American Industy Classification |

| |System (NAICS) |

| | |

| |Oilseed and grain farming |Poultry and egg production |

| |Vegetable and melon farming |Sheep and goat farming |

| |Fruit and tree nut farming |Animal aquaculture |

| |Greenhouse, nursery & floriculture production |Other animal production |

| |Other crop farming |Forestry and logging |

| |Cattle ranching and farming |Fishing, hunting and trapping |

| |Hog and Pig farming | |

| | |

| |Remaining Historic Fabric: Indicate whether the complex retains a High, Medium, or Low amount of its original |

| |historic fabric. This estimate, based on visual observation and/or archival research, includes architectural or |

| |engineering elements, landscapes, and any character defining features. |

| |Acreage: Give the total number of acres the farm currently covers. |

| |Farm Description: This section should be used to give the reader a clear mental image of the nature and type of |

| |agricultural complex being surveyed. It should note its basic type and layout as well as any character-defining |

| |features. References to materials, construction, and compositional techniques should be used whenever possible. This |

| |narrative should also elaborate upon all significant materials and designs, and discuss major alterations and their |

| |dates. On-site inspection and/or comparison with other complexes may lead to theories on construction, styles, dates,|

| |alterations, etc. |

| | |

Eligibility Worksheet Instructions

General Instructions:

This attachment should be used to assess eligibility for historic districts or individual properties for all intensive-level surveys. The worksheet should be attached to the Base Form or to the Historic District Overlay for the property or district in question. (Questions about completing the forms should be directed to the HPO.) There are some fields for which data lists are provided. In such cases, please choose the most appropriate word from the supplied list. For information that is not known, write "unknown" in the appropriate blank. Continuation sheets may be used for additional text, photographs, and other graphics.

Field Instructions:

|Historic Sites # |This field is for HPO use only. This number is an alphanumeric code used to uniquely identify all surveyed |

| |properties. This number will be assigned by the HPO once the form is received. For intensive-level surveys, this |

| |number will be the same for all attachments. |

| | |

|Surveyor Information |At the bottom of all pages, note the name of the survey, and include the name(s) of the person(s) completing the |

| |form. If two or more people were involved in the research and writing, include all names. Include the name(s) of the |

| |surveyor, preparer and sponsor, if different. Also include the date on which the form was completed. |

| | |

|History |Provide a concise factual history of the district or property being surveyed. The history should relate directly to |

| |the district or property; do not include an elaborate history of the area unrelated to the surviving built |

| |environment. The narrative should offer not only the history of the district or property, but also any historic |

| |contexts into which the district or property fits. A list of historic contexts available from the HPO can be found in|

| |Section 1.8 of the Architectural Survey Guidelines. |

| | |

|Statement of Significance |This field should be completed to aid in determining eligibility for the New Jersey and national Registers. |

| |Significance is placing the historical facts of the district or property into an historic context and determining |

| |whether the district or property is a physical representation of an important aspect of the past. Generally, the |

| |discussion should focus on the historical, architectural, archaeological, or environmental reasons for including it |

| |in the inventory. Indicate whether the district or property is rare or representative of the region. |

| | |

|Eligibility for New Jersey |Using your judgment and based on available information, indicate your opinion as to the eligibility of the district |

|and National Registers |or property. |

| | |

|National Register Criteria |If the district or property is evaluated as eligible, indicate under which of the National Register Criteria or |

| |Criteria Considerations it would fall. National Register Criteria and Criteria Considerations can be found in |

| |National Register Bulletin 15: How to Apply the National Register Criteria for Evaluation, U.S. Department of the |

| |Interior, National Park Service, Interagency Resources Division. |

| | |

|Level of Significance |Indicate if the district or property is significant at the Local, State, and/or National levels. |

| | |

|Justification of |Briefly state why the district or property should or should not be considered eligible for the New Jersey or National|

|Eligibility/Ineligibility |Registers (i.e. Rare or representative example or loss of integrity). |

| | |

|Narrative Boundary |Provide a complete description of the boundaries of the property or historic district. Include all relevant landmarks|

|Description |and features, and provide justification for the boundaries. |

| | |

|For Historic Districts Only | |

|Property Count |Indicate numerically how many key-contributing and non-contributing properties are located within the boundaries of |

| |the property or historic district. See National Register Bulletin 14: Guidelines for Counting Contributing and |

| |Non-Contributing Resources for National Register Documentation for additional information regarding counting |

| |resources. |

| | |

|For Individual Properties Only | |

|List of Attachments |In the space provided, list the completed attachments that relate to the significance of the property being |

| |documented. Attachments should be listed by the name of the element documented on the attachment. |

| | |

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